Case #372

Updated by Martti Virtanen almost 5 years ago

National ID: C515
Initiated: 2015-01-16
Initiator: Mats Fernström The Swedish National Board of Health and Welfare
Responsible at National organization: Mats Fernström The Swedish National Board of Health and Welfare
Sent to NordDRG Forum: 2015-01-27
Status: ACTITEM - Active item
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*Problem* Problem
It is quite common in healthcare that patients one manages a patient's problems are managed without having a direct contact of with the persions. This may patient at that time. It can be for consideration of medical problems, to issue a of certificate etc. based on the medical records etc. In Sweden they are called records. We call such events “VUP” which is short for “vårdhändelse utan patientkontakt” i.e. patientkontakt”. In English it should be something like “care events without patient contact”. Such events should shall not be reported to the national patent register but i happens. we see that in some places they do it anyway. Probably they need the data is needed for local their own statistics and but they forget to clean the material before submitting it then gets submitted to the national patient patent register. The situation is registgered with following procedure codes: codes used in this situations are:
WNFX00/AV097 Infection source and contact determination AV097 Smittspårning
R1R400/DV093 DV093 Generation of plan for rehabilitation
WRZA00/GD003 Long statement of health and health related matters
Upprättande av rehabiliteringsplan
WRZA00/GD001 GD001 Long statement of .../Anmälan Anmälan enligt lag
WRZA00/GD004 GD003 Long statement of .../Övriga Intyg, omfattande
GD004 Övriga
anmälningar
WRZA00/GD005 GD005 Long statement of .../Vårdintyg Vårdintyg
WRZA00/GD007 GD007 Long statement of .../Anmälan Anmälan för utredning enligt LVM
WRZA00/GD008 GD008 Long statement of .../Anmälan Anmälan enligt SoL angående barn med möjligt skyddsbehov
ZZZA40/XS004 XS004 Extensive specialist consultion with written report/Distanskonsultation Distanskonsultation
WSZA99/XS013 XS013 Other administration/Avstämningsmöte Avstämningsmöte med försäkringskassan


and then these events are grouped to DRG X63O Vårdadministrativa åtgärder, öppenvård (Healthcare administrative procedures, outpatient).

Sweden needs to separate the adimistrative cases with patient visit from those without a visit at the healthcare unit.

A real contact or visit at the healthcare provider is indicated either with LOS of at least 1 (day), with a significant intervention or with presence of a code indicating patient contact from the following list:

ZYZA40/XS003 Letter or telephone contact with patient
ZYZA40/XS011 Letter .../Information och rådgivning per telefon med företrädare för patienten
ZYZA40/XS012 Letter .../Information och rådgivning med patient per telefon
******/ZV044 Letter .../Behandling administrerad via internet

ZZZA00/XS902 Team of care providers/Teambesök
ZZZA00/XS007 Team of .../Konferens med patient
******/AV071 Team of .../Cancergenetisk utredning II
******/DV076 Team of .../Teamrehabilitering
******/XS008 Team of .../Konferens om patient

ZZZA10/XS903 Group of patients/Gruppbesök (i)
ZZZA10/XS901 Group of .../Deleted 2014/12/31-Gruppbesök eller gruppteambesök (i)
ZZZA10/XS904 Group of .../Gruppteambesök (i)
******/QV012 Group of .../Gruppträning
******/QX001 Group of .../Prevention av smittsamma sjukdomar
******/ZX903 Group of .../Kohortvård

ZZZA90/XS900 Outpatient visit/Enskilt besök

The ***** marked codes were not listed by Sweden but are linked to the same NCSP+ codes and will therefore inherit same properties as other linked codes, in the NCSP+ mapping is not changed.
Out of these the Swedish codes XS008 and QX001 are propblematic, because they clearly may happen without patient contact.

These codes would be given a new property 00X63 ‘Contact with patient or representative’

A new DRG is created 'Z630 - Administrative intervention without patient contact'

A new rule is created for this DRG in the NordDRG SWE before current rule X630 with

To prevent this grouping result and still keep the possibility for the hospitals to register “VUP” we suggest a new DRG, Z63O ‘Vårdadministrativa åtgärder utan patient kontakt’ (Healthcare administrative procedures without patient contact). The rule is similar to the rule for DRG X63O but no procedure codes for patient contact are allowed. This new rule is placed in DRG logic directly above the rule for DRG X63O. The exclusion of patient contacts is designed so that all procedure codes for patient contact:


XS003 Information och rådgivning med patient per brev
XS007 Konferens med patient
XS011 Information och rådgivning per telefon med företrädare för patienten
XS012 Information och rådgivning med patient per telefon
XS900 Enskilt besök
XS901 Deleted 2014/12/31-Gruppbesök eller gruppteambesök (i)
XS902 Teambesök
XS903 Gruppbesök (i)
XS904 Gruppteambesök (i)
are given a new DGPROP 00X63 ‘Contact with patient or representative’ and the value -00X63 (note the minus sign) is inserted in the Dgprop1 field in the new rule for DRG Z63O.


Analysis
The Swedish National Board of Health and Welfare – 2015-01-16
See above. This is a matter of principles and there is no need for cost analysis
Suggestion
The Swedish National Board of Health and Welfare – 2015-01-16
Sweden wants the new DRG, Z63O, described above to be introduced in NordDRG 2016 Swe.

Decided changes
The Swedish National Board of Health and Welfare – 2015-01-16
Sweden wants the new DRG, Z63O, described above to be introduced in NordDRG 2016 Swe.

DRG change
The patient cases that now are grouped to DRG X63O Vårdadministrativa åtgärder, öppenvård but where in reality there has been no patient contact will be grouped to DRG Z63O.
Technical change
The changes are briefly described above. For detailed technical changes see Excel-file “Decision C515 to Forum ”.

Introduction: NordDRG [SWE] [2016]

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